Individual
BRADEN ASHVIN PHETKHAMCHANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 TRUEBLOOD AVE, OSKALOOSA, IA 52577-1757
(641) 673-1093
Mailing address
1917 S STONEYBROOK ST, WICHITA, KS 67207-7111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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